Expandable interbody implant and corresponding inserter

ABSTRACT

An expandable implant may include an expandable body defined by a superior endplate and an inferior endplate that are hingedly coupled and may be expanded and lordosed by an external surgical tool. The superior endplate may include a first core having a distal engagement surface and the inferior endplate may a second core having a proximal engagement surface and a threaded screw aperture. The implant may include a threaded locking screw disposed in the threaded screw aperture and movable between a locked position and an unlocked position, for example. In the locked position, the threaded locking screw may urge the distal engagement surface of the first core into direct contact with the proximal engagement surface of the second core. The implant may include a pair of mounting tangs that may be sheared off and/or recesses. The locking screw may be a break-off screw.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation in part of U.S. patent application Ser. No. 17/356,950, titled EXPANDABLE INTERBODY IMPLANT, and filed Jun. 24, 2021. The entire disclosure of which is incorporated herein by reference. This application also incorporates by reference the entire contents of U.S. application Ser. No. 17/307,578, titled EXTERNALLY DRIVEN EXPANDABLE INTERBODY AND RELATED METHODS, and filed May 5, 2021.

FIELD

The present technology is generally related to an externally driven expandable interbody implant for use in a medical procedure related to the spine. In some embodiments, disclosed implants may be used in an anterior cervical discectomy and fusion (ACDF) procedure although other uses in other areas of the spine or between two bones are also contemplated.

BACKGROUND

Mechanically operated interbody implants may be used to align and/or realign a patient's spine during a medical procedure and/or for purposes of fusion, degenerative tissue and/or trauma/repair procedures. Conventional implants designed for the Thoracic and Lumbar region of the spine often include top and bottom endplates and a mechanical means to separate the top and bottom endplates. The mechanical mechanisms to separate the top and bottom endplates are often cumbersome and require a large footprint that is often unsuitable, for example, for ACDF type surgeries of the cervical portion of the spine.

SUMMARY

The techniques of this disclosure generally relate to an expandable interbody implant including a superior endplate and an inferior endplate hingedly coupled and which may further include a locking element to secure the inferior endplate and superior endplate in a particular configuration, for example. The superior and inferior endplates may be moved in a multitude of expanded and/or lordosed or kyphosed or otherwise angled configurations via an external inserter for example. In various embodiments, a locking screw may be a break-off type screw. In various embodiments at least one break-off tang on the implant may be used to for gripping of the implant to insert it into a disc space and afterwards the break-off tang may be broken off and removed. Additionally, in various embodiments the locking screw may be used to grip the implant and insert it into a disc space. Additionally, in various embodiments female recesses, rather than tangs, may be used for gripping of the implant and inserting the implant into a disc space.

In one aspect, the present disclosure provides for an expandable implant movable between a contracted position and an expanded position, for example. The expandable implant may include an expandable body extending from a proximal end to a distal end in a proximal-to-distal direction and extending from a first lateral side to a second lateral side in a widthwise direction, for example. The expandable body may be defined by a superior endplate and an inferior endplate opposite the superior endplate for example. In various embodiments, the superior endplate may include a channel located adjacent the distal end and extending in the widthwise direction, and a first core having a distal engagement surface, for example. In various embodiments, the inferior endplate may include a rail located adjacent the distal end and extending in the widthwise direction, the rail having a size and shape generally corresponding to a size and shape of the channel and being located within the channel, for example. In various embodiments, the inferior endplate may also include a second core having a proximal engagement surface and a threaded screw aperture, for example. In various embodiments, the implant may include a threaded locking screw disposed in the threaded screw aperture and movable between a locked position and an unlocked position, for example. Additionally, in various embodiments, in the locked position, the threaded locking screw may urge the distal engagement surface of the first core into direct contact with the proximal engagement surface of the second core, for example.

In another aspect, the disclosure provides for an expandable implant system. The system may include an inserter tool extending in a lengthwise direction from a proximal end thereof to a distal end thereof, the inserter tool may include a drive shaft supporting a drive end adjacent the distal end thereof and a pair of mounting arms adjacent the distal end thereof, for example. The system may also include an expandable implant movable between a contracted position and an expanded position, the expandable implant may include an expandable body extending from a proximal end to a distal end in a proximal-to-distal direction and extending from a first lateral side to a second lateral side in a widthwise direction, for example. In various embodiments, the expandable body may be defined by a superior endplate and an inferior endplate opposite the superior endplate, for example. In various embodiments, the superior endplate may include a channel located adjacent the distal end and extending in the widthwise direction, a first mounting tang and a first core having a distal engagement surface, for example. In various embodiments, the inferior endplate may include a rail located adjacent the distal end and extending in the widthwise direction, the rail may have a size and shape corresponding to a size and shape of the channel and be located within the channel, for example. The inferior endplate may also include a second mounting tang, and a second core having a proximal engagement surface and a threaded screw aperture, for example. In various embodiments, the system may further include a threaded locking screw disposed in the threaded screw aperture and movable between a locked position and an unlocked position, for example. In various embodiments, in the locked position, the threaded locking screw may urge the distal engagement surface of the first core into direct contact with the proximal engagement surface of the second core, for example. Additionally, in an insertion configuration, the first and second mounting tangs of the expandable implant may be disposed within the first and second mounting arms of the inserter tool, for example. Furthermore, in various embodiments, the drive end of the inserter tool may have a size and shape generally corresponding to a size and shape of a drive end of the threaded locking screw, for example.

The details of one or more aspects of the disclosure are set forth in the accompanying drawings and the description below. Other features, objects, and advantages of the techniques described in this disclosure will be apparent from the description and drawings, and from the claims.

BRIEF DESCRIPTION OF DRAWINGS

FIG. 1 is a perspective view of an expandable implant.

FIG. 2 is an alternate perspective view of an expandable implant.

FIG. 3 is a top down view of an expandable implant.

FIG. 4 is a side view of an expandable implant.

FIG. 5 is a rear view of an expandable implant.

FIG. 6 is a perspective view of the interior of a superior endplate of an expandable implant.

FIG. 7 is a perspective view of the interior of an inferior endplate of an expandable implant.

FIG. 8 is a perspective exploded parts view of an expandable implant.

FIG. 9 an exploded parts view of an expandable implant from a side view perspective.

FIG. 10 is a perspective cross section view of an expandable implant.

FIG. 11 is a cross section view of an expandable implant.

FIG. 12 is a side view of a superior endplate for use with at least some expandable implant embodiments.

FIG. 13A is a perspective view of a first expandable implant.

FIG. 13B is a perspective view of a second expandable implant.

FIG. 14A is a perspective view of a third expandable implant.

FIG. 14B is a perspective view of a fourth expandable implant.

FIG. 15 is a perspective view of a fifth expandable implant.

FIG. 16 is a side view of an expandable implant in the expanded configuration.

FIG. 17 is a side view of an expandable implant showing a bone screw trajectory.

FIG. 18 is a front view of an expandable implant.

FIG. 19 is a front view of an enlarged area of FIG. 18 .

FIG. 20 is a perspective view of an inserter for use with disclosed expandable implants.

FIG. 21 is a perspective view of an inserter for use with disclosed expandable implants shown in skeleton outlining for ease of understanding.

FIG. 22 is a perspective view of an inserter for use with disclosed expandable implants shown in skeleton outlining for ease of understanding.

FIG. 23A is a rear view of an inserter in a non-expanded position.

FIG. 23B is a rear view of an inserter in an expanded position.

FIG. 24 is an enlarged view of a distal end of an inserter in an expanded position coupled to an example expandable implant in a corresponding expanded position.

FIG. 25 is a perspective view of an expandable implant in an expanded configuration after a break-off portion of a locking screw has been broken off.

FIG. 26 is a perspective view of a surgical instrument for use with disclosed expandable implants.

FIG. 27 is a perspective view of a surgical instrument for use with disclosed expandable implants.

FIG. 28 is a perspective view of an expandable implant after the mounting tangs have been broken off.

FIG. 29 is a reference drawing showing the human spine of which various disclosed implant embodiments may be installed in.

FIG. 30 is a reference drawing showing various planes and reference directions of which the various disclosed implant embodiments may move in or act in with respect to a patient.

DETAILED DESCRIPTION

Embodiments of the present disclosure relate generally, for example, to spinal stabilization systems, and more particularly, to surgical instruments for use with spinal stabilization systems. Embodiments of the devices and methods are described below with reference to the Figures.

The following discussion omits or only briefly describes certain components, features and functionality related to medical implants, installation tools, and associated surgical techniques, which are apparent to those of ordinary skill in the art. It is noted that various embodiments are described in detail with reference to the drawings, in which like reference numerals represent like parts and assemblies throughout the several views, where possible. Reference to various embodiments does not limit the scope of the claims appended hereto because the embodiments are examples of the inventive concepts described herein. Additionally, any example(s) set forth in this specification are intended to be non-limiting and set forth some of the many possible embodiments applicable to the appended claims. Further, particular features described herein can be used in combination with other described features in each of the various possible combinations and permutations unless the context or other statements clearly indicate otherwise.

Terms such as “same,” “equal,” “planar,” “coplanar,” “parallel,” “perpendicular,” etc. as used herein are intended to encompass a meaning of exactly the same while also including variations that may occur, for example, due to manufacturing processes. The term “substantially” may be used herein to emphasize this meaning, particularly when the described embodiment has the same or nearly the same functionality or characteristic, unless the context or other statements clearly indicate otherwise.

Referring to FIGS. 1-19 generally, various embodiments and views of an expandable implant 100 are disclosed. Referring generally to FIGS. 20-25 various views of an inserter tool 200 for use with various expandable implant 100 embodiments are disclosed. Referring generally to FIGS. 26-28 various views of a break-off tool 300 for breaking off mounting tangs 19, 29 of various expandable implants 100 is disclosed. The components of expandable implant 100, inserter tool 200, and/or break-off tool 300 can be fabricated from biologically acceptable materials suitable for medical applications, including metals, synthetic polymers, ceramics and bone material and/or their composites. For example, the components, individually or collectively, can be fabricated from materials such as stainless steel alloys, commercially pure titanium, titanium alloys, Grade 5 titanium, super-elastic titanium alloys, cobalt-chrome alloys, superelastic metallic alloys (e.g., Nitinol, super elasto-plastic metals, such as GUM METAL®), ceramics and composites thereof such as calcium phosphate (e.g., SKELITE™), thermoplastics such as polyaryletherketone (PAEK) including polyetheretherketone (PEEK), polyetherketoneketone (PEKK) and polyetherketone (PEK), carbon-PEEK composites, PEEK-BaSO4 polymeric rubbers, polyethylene terephthalate (PET), fabric, silicone, polyurethane, silicone-polyurethane copolymers, polymeric rubbers, polyolefin rubbers, hydrogels, semi-rigid and rigid materials, elastomers, rubbers, thermoplastic elastomers, thermoset elastomers, elastomeric composites, rigid polymers including polyphenylene, polyamide, polyimide, polyetherimide, polyethylene, epoxy, bone material including autograft, allograft, xenograft or transgenic cortical and/or corticocancellous bone, and tissue growth or differentiation factors, partially resorbable materials, such as, for example, composites of metals and calcium-based ceramics, composites of PEEK and calcium based ceramics, composites of PEEK with resorbable polymers, totally resorbable materials, such as, for example, calcium based ceramics such as calcium phosphate, tri-calcium phosphate (TCP), hydroxyapatite (HA)-TCP, calcium sulfate, or other resorbable polymers such as polyaetide, polyglycolide, polytyrosine carbonate, polycaroplaetohe, polylactic acid or polylactide and their combinations.

Referring generally to FIGS. 1-5 various views of an expandable implant 100 in a collapsed position are illustrated. FIGS. 1-2 are various perspective views of an expandable implant 100. FIGS. 1-2 illustrate example perspective views of an expandable implant 100 in a partially expanded position and FIG. 3 is a top down view of an expandable implant 100. In the example embodiment, expandable implant 100 may include a proximal end 100P, a distal end 100D, and first and second lateral sides 100L. Additionally, a pair of bone screw apertures 11, 21 may be positioned on the proximal end 100P, for example. In various embodiments, bone screw apertures 11, 21 may comprise a corresponding bone screw retention mechanism 11 a, 21 a (may also be referred to as an anti-backout locking mechanism). In the example embodiment, the bone screw retention mechanisms 11 a, 21 a, comprise a flexible tang member having a hook portion at an end thereof that allows the flexible tang member to flex outward in a lateral direction away from the corresponding bone screw aperture 11, 21 during initial installation of the bone screw and to flex back inward towards the corresponding bone screw aperture 11, 21 to prevent a corresponding bone screw from backing out. For example, as the bone is installed in bone screw aperture 11, 21, the bone screw retention mechanism 11 a, 21 a, may flex outward as the underside of the head portion contacts inclined surface 11 c (see FIG. 19 ).

In various embodiments, and as illustrated in FIGS. 1-2 , mounting tangs 19, 29 may extend in a proximal direction, for example. In various embodiments, implant 100 may be referred to as an externally driven expandable implant because an end user or surgeon may use a surgical tool to open and close implant 100, e.g. expand implant 100. For example, an external tool may adjust the lordotic angle of implant 100 as will be explained in detail with respect to FIGS. 20-25 . Once implant 100 is expanded to an appropriate lordotic angle (also referred to as angle of inclination), an end user may fix the relative angle of the superior endplate 10 relative to the inferior endplate 20 by tightening locking screw 50, for example. In some embodiments, superior endplate 10 may be referred to as a “cephalad” endplate and inferior endplate 20 may be referred to as a “caudal” endplate.

Locking screw 50 may also be used in other embodiments, such as fixation of posterior rods, fixation of pedicle screws, and other set screw constructs. Additionally, locking screw 50 may be referred to as a “break-off screw” in some embodiments.

At least one advantage of relying on an external tool to adjust a lordotic angle of implant 100 may be the reduction of internal components within implant 100 relative to other forms of implants relying on various moving mechanisms and/or expansion mechanisms, for example. Accordingly, in various embodiments, implant 100 may have a relatively large void space in the interior thereof, which may facilitate a fusion process during an ACDF procedure. For example, implant 100 may have a relatively large internal volume 101 that is open through the superior endplate 10 and inferior endplate 20 which may be packed with bone graft material, for example.

As illustrated in FIG. 3 , implant 100 may extend in a proximal-to-distal direction (also referred to as a longitudinal direction) from the proximal end 100P to the distal end 100D though axis P-D through the center of the implant 100, for example. Implant 100 may extend in a widthwise direction (also referred to as lateral direction) from the first lateral side 100L to the second lateral side 100L through axis W-W through the center of the implant 100 and the center of locking screw 50, for example. The axis P-D may be perpendicular and/or substantially perpendicular to the axis W-W. For example, the proximal-to-distal direction may be perpendicular to the widthwise direction. Additionally, a width of the implant may taper from a proximal end 100P where it is widest towards a distal end 100D where it is narrowest.

FIG. 4 is a side view of an expandable implant 100. In the example illustration, it is shown that a superior endplate 10 is connected to an inferior endplate 20 such that the superior endplate may pivot about a hinge member 40. In the example embodiment, hinge member 40 comprises an arcuate rail portion of inferior endplate 20 that extends in the widthwise direction, for example. In the example embodiment, hinge member 40 may be nested into a corresponding arcuate cavity of the superior endplate 10 such that superior endplate 10 may expand and/or otherwise rotate about hinge member 40. Additionally, in various embodiments the superior endplate 10 and/or inferior endplate 20 may include various engagement elements 14 for engaging with an adjacent boney structure such as a vertebrae, for example. In the example embodiment, the engagement elements comprise a series of alternating rails and valleys therebetween that extend in the widthwise direction. However, claws, hooks, dimples, spikes, etc. are also contemplated as example engagement elements 14. In some embodiments, an acid etching process may be utilized to form a roughened or textured surface to facilitate securing the implant between boney portions and/or suppressing expulsion of implant 100.

FIG. 5 is a rear perspective view of an expandable implant 100. In the example illustration it is shown that the distal end 100D is narrower than the proximal end 100P. FIG. 6 is a perspective view of the interior of a superior endplate 10. In the example illustration, it is shown that the distal end of superior endplate 10 includes an arcuate channel 12 of which the hinge member 40 may be disposed inside of. The proximal end of superior endplate 10 may include a bone screw aperture cutout 21 b to allow a relief area for a corresponding bone screw to be insert through bone screw aperture 21 of inferior endplate 20, for example. Superior endplate 10 may also include a core 15 comprising an aperture 15 a that extends from a proximal surface 15 p thereof to a distal surface 15 d thereof, for example. In some embodiments, core 15 may be referred to as a support frame and take a generally rectangular shape. In various embodiments, the distal surface 15 d may be curved and generally face the distal end 100D of implant 100. FIG. 7 is a perspective view of the interior of an inferior endplate 20. In the example illustration, it is shown that the distal end of inferior endplate 20 includes a hinge member 40 in the form of an arcuate rail that may be disposed inside of the arcuate channel 12 of the superior endplate 10, for example. The proximal end of inferior endplate 20 may include a bone screw aperture cutout 11 b to allow a relief area for a corresponding bone screw to be insert through bone screw aperture 11 of superior endplate 10, for example. Inferior endplate 20 may also include a core 25 comprising a threaded aperture 25 a that extends from a proximal surface 25 p thereof to a distal surface 25 d thereof, for example. In some embodiments, core 25 may be referred to as a support frame and take a generally rectangular shape. In various embodiments, the superior endplate 10 and inferior endplate 20 may each be formed a unitary single piece, respectively.

FIG. 8 is a perspective exploded parts view and FIG. 9 is an exploded parts view from a side view perspective of an expandable implant 100. In the example embodiment, a locking screw 50 is illustrated. Locking screw 50 may include an external thread pattern 51 on an outside circumferential surface thereof, for example. The external thread pattern 51 of locking screw 50 may have a size and shape generally corresponding to the threaded aperture 25 a of core 25 of inferior endplate 20, for example. In various embodiments, an engagement surface 54 may be disposed adjacent and proximal of external thread pattern 51. In the example embodiment, engagement surface 54 is shaped like a washer and is directly connected to locking screw 50. However, in other embodiments, engagement surface 54 may be a washer or separated element, for example. In some embodiments, engagement surface 54 may be conically shaped. Engagement surface 54 may include a relatively planar and/or flat distal surface and/or proximal surface. In various embodiments, a proximal end of set screw 50 may include an aperture having an internal threaded surface 52. For example, a cylindrical shaped proximal end may include an aperture having a thread pattern disposed on an internal circumferential surface of the cylindrical shaped proximal end. In the example embodiment, a first drive feature 53 a and a second drive feature 53 b may be disposed adjacent to and distally with respect to a proximal most end of set screw 50. Additionally, first and second drive features 53 a, 53 b may be disposed proximally with respect to engagement surface 54. In the example embodiment, drive features 53 a, 53 b take a hexalobular shape, although various other shapes such as hexaganol, polygonal, torx, etc. are also contemplated. In some embodiments, a surgical drive tool having a corresponding socket may be coupled to drive features 53 a, 53 b to cause rotation of locking screw 50. Similarly, in some alternative embodiments, a drive tool with a protruding threaded member having a thread pattern with a corresponding size and shape to internal threaded surface 52 may also cause rotation of set screw 50.

As seen best in FIG. 9 , set screw 50 may also include a break-off location 55, for example. In the example embodiment, break-off location 55 is disposed directly between drive features 53 a, 53 b and is designed to shear off when a sufficient rotational force is applied to a proximal end of set screw 50 while a distal end of set screw 50 is stationary, e.g., when set screw 50 is secured in a locked position and a continued rotational force (torque) is applied to the proximal end of set screw 50 the drive feature 53 a and cylindrical end having the internal threaded surface 52 may break-off. As also seen best in FIG. 9 , the inferior endplate 20 may include a first relief 40 a and a second relief 40 b on opposite sides of hinge member 40. The first relief 40 a may have a size and shape corresponding to a size and shape of a first portion 12 a of superior endplate 10 and the second relief 40 b may have a size and shape corresponding to a size and shape of a second portion 12 b of superior endplate 10, for example. In various embodiments, portions 12 a, 12 b may comprise a hook shape, outdent, and/or protrusion, for example. In the example embodiment, portions 12 a, 12 b may be disposed on opposite sides of channel 12 and cup hinge member 40 such that the superior endplate 10 and inferior endplate 20 may rotate relative to one another without becoming uncoupled.

FIG. 10 is a perspective cross section view and FIG. 11 is a cross section view of expandable implant 100. In the example embodiment, the superior endplate 10 and inferior endplate 20 are coupled together by hinge member 40, and core 25 may be positioned behind of core 15, e.g., core 25 may be positioned distally with respect to core 15. Additionally, the outside external thread pattern 51 of locking screw 50 may engage with the threaded aperture 25 a of the core 25 and extend through aperture 15 a of core 15. In this way, when locking screw 50 is rotated, the distal surface 15 d of core 15 may engage with the proximal surface 25 p of core 25. For example, by tightening locking screw 50 the engagement surface 54 of locking screw 50 pushes against the proximal surface 15 p of core 15 thereby bringing the superior endplate 10 and inferior endplate 20 into frictional engagement.

FIG. 12 is a side view of a superior endplate 10 for use with at least some expandable implant 100 embodiments. In the example embodiment, superior endplate 10 may include an arcuate channel 12 of which the hinge member 40 may be disposed inside of. In various embodiments, arcuate channel 12 may be defined by a first circle having a center point at P₁ and/or a segment of the circle having the center point at P₁. The center point P₁ may define an axis of rotation that superior endplate 10 may rotate and/or pivot with respect to inferior endplate 20. For example, superior endplate 10 may be hingedly coupled to hinge member 40 as explained above and rotatable about an axis of rotation defined by center point P₁, for example. Additionally, in various embodiments a distal surface 15 d of core 15 may be a curved surface defined (in part or in total) by a second circle having a center point at P₁ and a radius R₁. The proximal surface 15 p of core 15 may also be a curved surface defined (in part or in total) by a segment of a circle having a radius R₂ and a center point P₂. In the example embodiment, P₂ is located a distance D₁ above point P₁ and radius R₂ is greater than radius R₁. Additionally, the proximal surface 15 p of core 15 is offset a distance D₂ from the proximal most face of the superior endplate 10. In the example embodiment, center point P₂ is vertically above center point P₁ however, in other embodiments, center point P₂ may be offset by a greater amount or even a lesser amount than illustrated. In some examples, P₂ may not be aligned vertically above P₁. In various embodiments, R₁ may be about 7-9 mm+/− about 1 mm and R₂ may be about 8-10 mm+/− about 1 mm although these numbers may be modified in some embodiments having a larger or smaller footprint. In various embodiments D₁ is about 0.25 mm to about 1.0 mm and D₂ is about 0.25 mm to about 1.25 mm. In at least one embodiment, D₁ is about 0.75 mm and D₂ is about 0.8 mm and R₂ is about 9.2 mm.

The above explained geometrical relationship between the offset center points P₁ and P₂ and R₁ and R₂ may have several advantages in terms of operability and functionality. At least one advantage is that the superior endplate 10 may have a natural tendency to apply a force against the engagement surface 54 of locking screw 50 such that locking screw 50 may function similar to a wedge preventing implant 100 from fully collapsing. Another advantage is that a biasing force may be applied that naturally urges the superior endplate 10 and inferior endplate 20 into an expanded position which may assist with expanding the implant 100 when positioned between a superior vertebrae and an inferior vertebrae, for example. For example still, an end user such as a surgeon may expand implant 100 and the offset arrangement explained above may facilitate the function of keeping implant 100 lordosed at the chosen angle.

FIG. 13A is a perspective view of a first expandable implant, FIG. 13B is a perspective view of a second expandable implant, FIG. 14A is a perspective view of a third expandable implant, FIG. 14B is a perspective view of a fourth expandable implant, and FIG. 15 is a perspective view of a fifth expandable implant. In the series of illustrations it is shown that various embodiments in accordance with the principles of this disclosure may be variously sized depending on the particular location in a human body and the particular patient specific human anatomy. For example, FIG. 13A illustrates a first expandable implant 100 having a first height H₁ or thickness between the superior endplate 10 and inferior endplate 20, FIG. 13B illustrates a second expandable implant 100 having a second height H₂ or thickness, FIG. 14A illustrates a third expandable implant 100 having a third height H₃ or thickness, FIG. 14B illustrates a fourth expandable implant 100 having a fourth height H₄ or thickness, and FIG. 15 illustrates a fifth expandable implant 100 having a fifth height H₅ or thickness. In at least some embodiments, H₁ may be about 5 mm, H₂ may be about 6 mm, H₃ may be about 7 mm, H₄ may be about 8 mm, H₅ may about 9 mm, for example. In various embodiments, an angle of inclination between the superior endplate 10 and inferior endplate 20 may be about 4 degrees to about 15 degrees in an expanded configuration, e.g., an angled and/or inclined configuration.

FIG. 16 is a side view of an expandable implant 100 in the expanded configuration. In an expanded position, a distance D₃ between the superior endplate 10 and inferior endplate 20 at the proximal end 100P may be relatively greater than in the closed configuration, for example. Additionally, an angle of inclination a may be relatively greater in an expanded position than in the closed configuration, for example. In this embodiment, implant 100 may have a height H₁ corresponding to FIG. 13A and be about 5 mm in a closed configuration. In the illustrated expanded configuration of FIG. 16 , D₃ may be about 8 mm to 9 mm and a may be about 10 degrees to about 20 degrees. In at least one embodiment, D₃ may be 8 mm in a fully expanded position and a may be about 15 degrees, for example.

FIG. 17 is a side view of an expandable implant 100 showing a bone screw trajectory 99. In the example embodiment, it is shown that a centered bone screw trajectory 99 of bone screw 97 is at an angle β with respect to a plane 98 that crosses through a center of the implant from a first lateral side to a second lateral side, for example. Additionally, the bone screw trajectory 99 may be varied +/− by a degree γ, for example. In various embodiments, β may be about 30 degrees to about 50 degrees and γ may be about 2 degrees to about 10 degrees. In the example embodiment, β may be about 40 degrees and γ may be about 5 degrees.

FIG. 18 is a front view of an expandable implant showing an area A₁ and FIG. 19 is a front view of an enlarged area A₁ of FIG. 18 . In the example embodiment, bone screw 97 is in a position extending through bone screw aperture 11 where it cannot backout due to bone screw retention mechanism 11 a. The bone screw retention mechanism 11 a includes an inclined surface 11 c such that when bone screw 97 is being installed, an underside of the head portion of bone screw 97 directly contacts the inclined surface 11 c thereby pushing the bone screw retention mechanism 11 a laterally outward and away from bone screw aperture 11, for example. Thereafter, when bone screw 97 is installed and the head portion of bone screw 97 is beneath inclined surface 11 c the bone screw retention mechanism may flex back towards bone screw aperture 11 such that it will prevent bone screw 97 from backing out, e.g., a blocking surface of bone screw retention mechanism 11 a may contact an upper surface of the head portion of bone screw 97. In the example embodiment, bone screw retention mechanism 11 a comprises flexible arm (or spring tab) having an inclined surface 11 c (or ramp) that is disposed on a lateral end of implant 100 adjacent bone screw aperture 11.

Referring generally to FIGS. 20-24 an inserter 200 for use with disclosed expandable implants 100 is illustrated. Inserter 200 may extend in a longitudinal direction from a proximal end 200 p to a distal end 200 d, for example. Inserter 200 may include a pair of handles 230, a handle lock 202, and mounting arms 210 for securely coupling to mounting tangs 19, 29 of implant 100, for example. Inserter 200 may further include a tightening knob 211 that is connected to a drive shaft 220 having a drive end 221. Drive end 221 may have a size and shape generally corresponding to a size and shape of the various drive features of locking screw 50, for example the internal threaded surface 52, first drive feature 53 a, and/or second drive feature 53 b. In the example embodiment shown in FIG. 24 , drive end 221 includes an end portion having an outside threaded surface with a corresponding size and shape to the internal threaded surface 52 of locking screw 50. In various embodiments, tightening knob 211 may rotate drive shaft 220 and drive end 221 to engage drive end 221 with locking screw 50 and pull implant 100 towards inserter tool 200 such that mounting tangs 19, 29 are securely nested within corresponding channels of mounting arms 210. Additionally, an end user may rotate inserter 200 thereby translating a rotational force through drive end 221 to locking screw 50, e.g., via first drive feature 53 a, and/or second drive feature 53 b.

As seen best in FIGS. 23A and 23B, inserter 200 may include a pair of handles 230, a stationary arm 252, a primary pivoting arm 250, and a secondary pivoting arm 251. For example, to expand implant 100 an end user may toggle handle lock 202 to an unlocked position and push down on thumb indentation 231 of the handle 230 that is connected to the primary pivoting arm 250 and secondary pivoting arm 251. In doing so, primary pivoting arm 250 may pivot with respect to medial pivot point 240 and secondary pivoting arm 251 may pivot with respect to distal pivot point 245, for example. The path of travel of secondary pivoting arm 251 may lift up on the corresponding mounting tang 19 or 29 and cause the superior endplate 10 and inferior endplate 20 to separate from one another at the proximal end, for example. In doing so, an end user can lordose implant 100 to a desired angle. For example, as seen best in FIG. 24 , secondary pivoting arm 251 has lifted up on mounting tang 19, which is nested in a corresponding channel of mounting arm 210.

Once implant 100 is lordosed to a desired configuration, an end user may rotate drive shaft 220 and drive end 221 to tighten locking screw 50 as explained previously. After locking screw 50 is relatively tight, the end user may continue to apply a rotational force to locking screw 50 until a proximal portion comprising the cylindrical part having an internal threaded surface 52, and the first drive feature 53 a breaks off at break-off location 55. For example, once locking screw 50 is tightened to a designed torque, the locking screw 50 may shear off as explained previously. At least one advantage of utilizing the locking screw 50, is that it may prevent over tightening which can cause deformation to implant 100. As shown in FIG. 25 , implant 100 has been expanded to a desired position and/or lordotic angle. Additionally, locking screw 50 has locked the relative position of the superior endplate 10 with respect to the inferior endplate 20 and the proximal portion of locking screw 50 has been broken off as explained above.

FIGS. 26 and 27 are various views of a surgical instrument 300 for use with disclosed expandable implants 100. In some embodiments, surgical instrument 300 may be referred to as a break-off instrument and may be used to break-off the mounting tangs 19, 29 of implant 100. In the example embodiment, surgical instrument 300 comprises a first instrument 310 and a second instrument 320. First instrument 310 may extend in a longitudinal direction from handle 312 towards gripping end 311. Similarly, second instrument 320 may extend in a longitudinal direction from handle 322 to gripping end 321. Gripping ends 311, 321 may comprise a channel having a size and shape generally corresponding to mounting tangs 19, 29. For example, as seen best in FIG. 27 , the mounting tangs 19, 29 may be insert inside of the corresponding channels of gripping ends 311, 321. After the mounting tangs 19, 29 are nested within gripping ends 311, 321 an end user may push laterally outward and/or inward against handles 312, 322 to break-off the corresponding mounting tang 19, 29. For example, as shown in FIG. 28 expandable implant 100 is in an expanded and lordosed configuration and the proximal portion of locking screw 50 and tangs 19, 29 have been broken off.

FIG. 29 is a reference drawing showing the human spine of which various disclosed implant embodiments may be installed in. FIG. 30 is a reference drawing showing various planes and reference directions of which the various disclosed implant embodiments may move in or act in with reference to a patient 1.

It should be understood that various aspects disclosed herein may be combined in different combinations than the combinations specifically presented in the description and accompanying drawings. For example, features, functionality, and components from one embodiment may be combined with another embodiment and vice versa unless the context clearly indicates otherwise. Similarly, features, functionality, and components may be omitted unless the context clearly indicates otherwise. It should also be understood that, depending on the example, certain acts or events of any of the processes or methods described herein may be performed in a different sequence, may be added, merged, or left out altogether (e.g., all described acts or events may not be necessary to carry out the techniques).

Unless otherwise specifically defined herein, all terms are to be given their broadest possible interpretation including meanings implied from the specification as well as meanings understood by those skilled in the art and/or as defined in dictionaries, treatises, etc. It must also be noted that, as used in the specification and the appended claims, the singular forms “a,” “an” and “the” include plural referents unless otherwise specified, and that the terms “comprises” and/or “comprising,” when used in this specification, specify the presence of stated features, elements, and/or components, but do not preclude the presence or addition of one or more other features, steps, operations, elements, components, and/or groups thereof. 

What is claimed is:
 1. An expandable implant movable between a contracted position and an expanded position, comprising: an expandable body extending from a proximal end to a distal end in a proximal-to-distal direction and extending from a first lateral side to a second lateral side in a widthwise direction, the expandable body being defined by a superior endplate and an inferior endplate opposite the superior endplate; the superior endplate comprises: a channel located adjacent the distal end and extending in the widthwise direction; and a first core having a distal engagement surface; the inferior endplate comprises: a rail located adjacent the distal end and extending in the widthwise direction, the rail having a size and shape generally corresponding to a size and shape of the channel and being located within the channel; and a second core having a proximal engagement surface and a threaded screw aperture; a threaded locking screw disposed in the threaded screw aperture and movable between a locked position and an unlocked position, wherein, in the locked position, the threaded locking screw urges the distal engagement surface of the first core into direct contact with the proximal engagement surface of the second core.
 2. The expandable implant of claim 1, wherein: the superior endplate comprises a first mounting tang extending from a proximal end of the superior endplate; and the inferior endplate comprises a second mounting tang extending from a proximal end of the inferior endplate, wherein the first mounting tang is disposed opposite the second mounting tang.
 3. The expandable implant of claim 2, wherein: the first mounting tang comprises a first break-off location; and the second mounting tang comprises a second break-off location.
 4. The expandable implant of claim 1, wherein: the superior endplate comprises a first bone screw aperture disposed on the proximal end of the superior endplate; and the inferior endplate comprises a second bone screw aperture disposed on the proximal end of the inferior endplate.
 5. The expandable implant of claim 1, wherein: the channel located adjacent the distal end of the superior endplate extends in the widthwise direction from the first lateral side to the second lateral side; and the rail located adjacent the distal end of the inferior endplate extends in the widthwise direction from the first lateral side to the second lateral side.
 6. The expandable implant of claim 5, wherein: the superior endplate comprises at least one hook portion adjacent the channel; the inferior endplate comprises at least one relief portion adjacent the rail; the at least one hook portion has a size and shape generally corresponding to a size and shape of the at least one relief portion; and the at least one hook portion is disposed within the at least one relief portion.
 7. The expandable implant of claim 6, wherein, in a cross-section view, the channel comprises an arcuate shape and the rail comprises an arcuate shape.
 8. The expandable implant of claim 1, wherein the first core is disposed proximally with respect to the second core and the locking screw extends through the first core.
 9. The expandable implant of claim 1, wherein the locking screw comprises a break-off portion.
 10. The expandable implant of claim 1, wherein the locking screw comprises an interior having an exposed circumferential surface including a thread pattern.
 11. The expandable implant of claim 1, wherein the implant is expandable via a first mounting tang disposed on the proximal end of the superior endplate and a second mounting tang disposed on the proximal end of the inferior endplate.
 12. The expandable implant of claim 1, wherein: the distal surface of the first core comprises a first curved surface; the proximal surface of the second core comprises a second curved surface; the first curved surface is defined by a radius of a circle having a center point that is offset from an axis of rotation of the rail.
 13. The expandable implant of claim 1, wherein: the superior endplate comprises a first bone screw aperture disposed on the proximal end of the superior endplate and a first flexible bone screw retention arm for retaining a first bone screw positioned within the first bone screw aperture; and the inferior endplate comprises a second bone screw aperture disposed on the proximal end of the inferior endplate and a second flexible bone screw retention arm for retaining a second bone screw positioned within the first bone screw aperture.
 14. The expandable implant of claim 13, wherein: the first flexible bone screw retention arm includes a first inclined surface and the second flexible bone screw retention arm includes a second inclined surface.
 15. An expandable implant system, comprising: an inserter tool extending in a lengthwise direction from a proximal end thereof to a distal end thereof, the inserter tool including a drive shaft supporting a drive end adjacent the distal end thereof and a pair of mounting arms adjacent the distal end thereof; an expandable implant movable between a contracted position and an expanded position, the expandable implant comprising an expandable body extending from a proximal end to a distal end in a proximal-to-distal direction and extending from a first lateral side to a second lateral side in a widthwise direction, the expandable body being defined by a superior endplate and an inferior endplate opposite the superior endplate; the superior endplate comprises: a channel located adjacent the distal end and extending in the widthwise direction; a first mounting tang; and a first core having a distal engagement surface; the inferior endplate comprises: a rail located adjacent the distal end and extending in the widthwise direction, the rail having a size and shape corresponding to a size and shape of the channel and being located within the channel; a second mounting tang; and a second core having a proximal engagement surface and a threaded screw aperture; a threaded locking screw disposed in the threaded screw aperture and movable between a locked position and an unlocked position, wherein, in the locked position, the threaded locking screw urges the distal engagement surface of the first core into direct contact with the proximal engagement surface of the second core, wherein, in an insertion configuration, the first and second mounting tangs of the expandable implant are disposed within the first and second mounting arms of the inserter tool, and wherein the drive end of the inserter tool has a size and shape generally corresponding to a size and shape of a drive end of the threaded locking screw.
 16. The system of claim 15, wherein the locking screw comprises a break-off portion.
 17. The system of claim 16, wherein the drive end of the inserter is configured to shear off the break-off portion of the locking screw.
 18. The system of claim 15, wherein: the first mounting tang extends from a proximal end of the superior endplate; and the second mounting tang extends from a proximal end of the inferior endplate, wherein the first mounting tang is disposed opposite the second mounting tang.
 19. The system of claim 18, wherein: the first mounting tang comprises a first break-off location; and the second mounting tang comprises a second break-off location.
 20. The system of claim 19, comprising: a break-off tool extending in a lengthwise direction from a proximal end thereof to a distal end thereof, the proximal end comprising a handle and the distal end comprising at least one channel for receiving and breaking off at least one of the first mounting tang and/or second mounting tang. 